13 August 2009

Right now one of the big “issues” surrounding health insurance reform is that by putting a mandate for coverage of “end-of-life counseling” costs into the bill, we’ll be condemning the sick, the disabled, the injured and the elderly to euthanasia.

This is ridiculous.

I recently had that counseling myself. I had a routine quarterly appointment with my VA rheumatologist a few weeks ago. During the pre-appointment check-up (weight, temperature, blood pressure, “how are you feeling today?” questions), the nurse surprised me by asking, “Have you thought about doing an advance health care directive?”

Caught off guard, I stammered that I had, indeed, thought of it, but hadn’t followed through.

So she explained exactly what it was and went on, saying gently that while this sort of thing is uncomfortable to think about when we’re relatively young and healthy, we never really know what tomorrow might bring. By filling out an AHCD, the nurse explained, I can make it clear how I wish my family and doctors to care for me should I ever become so severely ill or injured that I’m unable to make that decision myself.

This is both sane and sensible. I wouldn’t want to be a living vegetable, kept alive indefinitely by machines, running up horrendous, impossible hospital and doctor bills that would certainly bankrupt and impoverish my family. What a horror! I don’t know anyone who would want that, personally, but I realize that there are some people who feel that as long as there’s life, there’s hope for recovery. I respect their feelings, even if I don’t agree.

The thing is, by having an advance health care directive available, people who do want heroic measures taken to keep them alive can make that perfectly clear, in writing, in the directive. And it’s a binding document.

The AHCD takes that horrible decision out of the hands of my grieving family members and makes it my decision, no matter what.

The VA nurse at my appointment was doing exactly the “end-of-life counseling” that would be covered by every health care insurance plan if the bill passes. All it means is that rather than having to pay for that counseling, the individual would get it for no cost. I don’t know about you, but I think arguing against free counseling is pretty silly.

The VA nurse didn’t force me to do anything. She simply informed me of the potential importance of such a directive, filled out voluntarily by myself. She told me how to get the paperwork through the VA should I wish to go ahead. She also explained that I could change that directive at any time after it was made. I’d simply submit a new one if I changed my mind regarding what sort of care I wanted at the end of my life.

And that was it. Sure, it was a surprise to find myself talking about my inevitable death in such a routine way. None of us really wants to think about that. But I left that appointment knowing more than I had before I walked in. I left with something to think about. And I’ve decided that I will, indeed, fill out that paperwork and take the simple steps necessary to make it legal and binding. Instead of frightening me, the idea gives me a sense of peace, knowing that when the time comes for me to die, I’ll die. That event will be hard enough on my family without bankrupting them by dragging it out indefinitely.

Want to learn more? Click on this link for a good explanation of what an advance health care directive is.

"... it appears, according to the Wall Street Journal, that the Senate Finance Committee will not be including a provision to reimburse Medicare doctors who provide end-of-life counseling to dying patients in its bill."

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